[Hiring] Provider Reimbursement Specialist @UnitedHealth Group

Role Description

Optum has an immediate opening for a Provider Reimbursement Specialist.

Schedule: Mon - Fri, 8:00AM - 5:00PM any time zone that you reside within. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

• Research and develop applicable business rules that support product reimbursement methodologies and policies for existing and new business opportunities.
• Develop and submit fee schedules and/or provider rates to claim pricing platforms.
• Perform post-load quality analysis review on relevant claim platform submissions and provide correction instructions if necessary.
• Write technical specifications or business requirements that support the development of business applications or existing system enhancements.
• Perform and/or review user acceptance testing of relevant applications (e.g., support fee schedule; rate submissions; fee builder tool; claim editing system; claim pricing system).
• Write internal operational and/or reimbursement policies that support global functions.
• Work with business partners to develop and/or create provider agreements and payment appendices to reflect terms of the provider’s reimbursement strategies.
• Research new opportunities to improve operating efficiencies, implement medical cost savings and/or reduce administrative expenses, and provide appropriate recommendations to applicable audiences.
• Review State websites for the markets assigned on a weekly basis to research any Fee Schedule changes and submit to PCRL to ensure most appropriate pricing is documented and loaded in our systems.
• Performs other duties as assigned.

Qualifications

• High School Diploma/GED
• 2+ years of experience working on CSP FACETs
• 1+ years of experience supporting professional reimbursement
• 1+ years of experience with provider contracts and/or interpretation of the State requirements but not limited to RFPs and contracts
• Intermediate to Advanced level of proficiency in Microsoft programs including Excel and Word
• Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)
• Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Requirements

• Experience in medical billing, claims processing or contract installation including experience with professional reimbursement methodologies
• Claims processing or resolution experience
• Experience managing multiple projects concurrently, while maintaining a high level of quality and commitment to project timeframes
• Experience training others on core job functions
• Experience in a role exposing you to provider contract
• Undergraduate degree or equivalent

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)